Psychodynamic Therapy

Psychodynamic psychotherapy is deeply rooted in the therapeutic relationship between the client and therapist. It's vital for professionals using this method to provide a safe, supportive environment so patients can freely express their thoughts and feelings without censorship or judgment.

Psychodynamic therapy is often longer-term than other therapeutic approaches because it aims to delve deeply into unconscious processes and patterns that may have developed over a person's lifetime.

Typically, professionals schooled in this method begin by exploring a few fundamental basics:

• Early childhood experiences: Since psychotherapists place great emphasis on early childhood experiences, they may focus on learning about a patient's early relationships with parents or caregivers. This can help uncover unresolved conflicts from childhood that influence present-day difficulties.
• The unconscious mind: PDT operates on the notion that a significant portion of an individual's thoughts, feelings, and motivations lie outside of conscious awareness. By working with the patient on exploring the unconscious mind, the therapist can provide insights into behavior patterns and emotions.

Psychodynamic therapy has various branches and approaches within psychodynamic psychology. Some psychologists also use psychodynamic theories combined with other schools of psychoanalysis to shape how they work with individual patients. 

For example, self-psychological therapy—which has both long- and short-term versions—grew out of the psychodynamic theory of self psychology developed by Heinz Kohut. Kohut’s ideas differed from those of Sigmund Freud regarding the sources of mental health challenges, focusing more on the parent-child relationship. As a result, self-psychological therapy takes a more relational approach to treatment.

When engaging in PDT, patients can typically expect a preliminary evaluation, during which the therapist learns about the individual's thoughts, feelings, relationships, and behavior. With this information, the therapist can establish a diagnosis¹ using specific criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

During this first contact, the psychologist may also attempt to gather as much information as possible about the patient's life history, including traumatic experiences, losses, relationships, accomplishments, strengths and weaknesses, and any other factors that the patient/psychologist feels are relevant for therapy. 

Once the initial evaluation is complete, a treatment plan is developed according to the individual's needs. As treatment commences, the therapeutic direction may change as more information is uncovered to accommodate growth and changes in the patient's experiences. 

Therapists practicing PDT may focus on helping patients cope with their challenges independently; therefore, they don't include what could be construed as personal advice in the treatment process. Instead, they provide patients with the tools they need to understand themselves better and accomplish their life goals. 

PDT is beneficial for people experiencing symptoms of psychological distress² caused by a mental health disorder. Research indicates that psychodynamic therapy is effective in treating many serious psychological conditions, including, but not limited to:

• Anxiety
• Depression
• Substance use disorder
• Eating disorders
• Psychosis
• Personality disorders
• Post-traumatic stress disorder
• Panic Disorder
• Obsessive Compulsive Disorder 

PDT is effective for individual therapy but can also be applied in a group setting or couples counseling.

This type of therapy may also be utilized by people looking to learn more about themselves and explore the potential origins of their behaviors and motivations. For example, people experiencing challenges with interpersonal relationships may look to tenets of psychodynamic therapy to examine the sources of defense mechanisms they may use to protect themselves from the painful emotions they may experience that contribute to conflict. 

Some may also be interested in learning more about their subconscious through dream analysis, a key concept in PDT. Because dreams are seen as windows into the unconscious mind, exploring their symbolism and content can reveal hidden thoughts and emotions.

The goals of PDT often vary depending on the patient, their circumstances, and the judgment of their psychologist. However, there are three fundamental benchmarks that therapists aim for when treating patients using psychodynamic therapy:

• Guiding the patient in understanding how the subconscious works: Teaching subconscious self-awareness can help individuals discover the root causes of their emotional distress and help them work through unresolved challenges. 
• Teaching the patient to recognize how their past affects the present: Because personal experiences play a significant role in an individual's growth and development, psychotherapists also work to help patients recognize how their past has shaped their thoughts, emotions, and behaviors. Once they've gained insight, the patient may develop a healthier outlook and more productive coping skills. 
• Aiding the patient in examining their interpersonal relationships more deeply: Psychodynamic therapists may stay mindful of "transference" within the patient/therapist dynamic for better insight into a patient's interpersonal difficulties. Transference refers to unconsciously transferring feelings about an individual in one's past onto their therapist. 

Transference can be a valuable tool in helping patients better understand how their emotional experiences in past relationships can influence their current relationships. While the focus is often on an individual's past relationship with a parent or caregiver, transference may also stem from emotional difficulty or traumatic experiences in any past relationship. 

Transference isn't necessarily always rooted in unpleasant experiences. There are other types of transference that therapists may expect to encounter.

One such type is called positive transference. This is when a patient transfers positive aspects of past relationships onto the therapist. For example, the patient may see the therapist as supportive, empathetic, and wise.

Some therapists may also encounter sexualized transference when a patient experiences feelings of attraction toward their therapist. These may include romantic feelings, sexual attraction, feelings of intimacy, or reverence. 

Current research into psychodynamic therapy reveals this method is malleable and can provide a strong foundation for other treatment types. 

For example, a recent narrative synthesis of findings from 82 studies of children and adolescents found evidence across studies that psychodynamic therapy is effective for treating a range of mental health disorders—particularly personality disorders and internalizing disorders such as anxiety and depression. Researchers also determined that PDT helps treat the comorbid conditions of more severe disorders. 

Another form of PDT, short-term psychodynamic psychotherapy (STPP), has also been studied as a viable form of treatment for different disorders. One meta-analysis reviewed data from 37 randomized controlled trials on short-term psychodynamic psychotherapy as a treatment for functional somatic disorders (FSD) such as chronic fatigue syndrome, irritable bowel syndrome, tension headache, and temporomandibular disorder. The findings suggest that short-term psychodynamic therapy is a solid treatment option for reducing somatic symptoms.  

A follow-up review found that across studies, the symptoms of these types of disorders improved considerably with short-term psychodynamic therapy from pre-treatment through long-term follow-up. The treatment was also effective in treating comorbid conditions such as depression and anxiety and alleviating external conditions such as disability and interpersonal difficulties. 

In a systematic review of 12 studies, researchers examined the efficacy of psychodynamic therapy compared to cognitive behavioral therapy for post-traumatic stress disorder. Studies that compared the two modalities showed that cognitive behavioral therapy was superior to psychodynamic therapy. However, the researchers concluded that, overall, psychodynamic therapy is a viable alternative to cognitive behavioral therapy for the treatment of post-traumatic stress disorder. 

The results of one included study suggest that psychodynamic therapy can alleviate multiple negative effects of post-traumatic stress disorder, including dissociation and overall distress. In another study, participants reported experiencing significant improvements in symptoms of post-traumatic stress disorder following long-term group psychodynamic therapy.

In a broad-based review published in American Psychologist, several meta-analyses were examined. The results of the included studies suggest that psychodynamic therapy is as effective as more recently developed modalities for a range of disorders—and potentially more effective over the long term. One meta-analysis, which included over 1,400 participants, showed that effect sizes increased substantially at follow-up for individuals who had undergone psychodynamic therapy.

While the quantity and quality of such studies have increased with time, more research is required to explore the further potential of PDT as a viable treatment method for an expanding range of demographics and mental health conditions.